Morphological variation and airflow dynamics in the human nose.

Airflow dynamics are recognized as being important to the functioning of the human nose in conditioning and filtering inspired air, yet these dynamics are poorly understood. Despite considerable research on airflow dynamics by otolaryngologists, respiratory physiologists, and toxicologists, major disagreements remain about the nature of airflow in the human nose. Specifically, there is little consensus about the character of nasal airflow regimes (laminar or turbulent) and about the major pathways of airflow through the internal chamber. Additionally, a number of features in the human nose have been argued to enhance airflow turbulence, thus increasing the exposure of moving air to the nasal mucosa and facilitating heat and moisture exchange in cold and/or dry climates. These features include: an inferior orientation of the nares; a nasal sill that is high relative to the floor of the internal nasal chamber; a nasal valve that is small in cross-sectional area relative to that of the internal chamber; and large, projecting conchae. The claim that these features affect airflow dynamics has never been tested. To clarify the nature of human nasal airflow and to test these claims of functional significance to nasal variation, we studied airflow across physiological flow rates using water and dye flowing through anatomically accurate acrylic models of human nasal air passageways (with adjustment of water flow rates to maintain dynamic similarity). The models were derived from direct casting of the nasal passageways of 10 Caucasian ("leptorrhine") cadavers (six male, four female). Measures of naris angle, nasal sill height, nasal valve area relative to internal chamber cross-sectional area, and relative projection of the inferior and middle turbinates were taken directly on the resulting casts. The relationships between aspects of nasal morphology and turbulent air flow were evaluated by examining the flow regimes (laminar, semiturbulent, or turbulent) at varying flow rates, with the expectation that the greater the development of the proposed turbulence-enhancing features the slower the flow rate at which flow would shift from one regime to another. Flow characteristics (both flow regimes and principal pathways) were highly variable within our sample. The relative projection of the inferior turbinate was the only variable that significantly affected the flow rate at which flow became turbulent. However, more projecting turbinates appear to laminate flow rather than to induce turbulence. Nostril orientation was moderately correlated with flow dynamics (with more inferiorly directed nares producing turbulence at slower flow rates), but this correlation was not statistically significant. Relative nasal valve area and nasal sill height were unrelated to turbulence in our models.     

Findings of massive pneumatization of the middle nasal turbinate in a collection of skulls from the 13th-18th centuries

Ethmoid cells display a considerable variability due to their extensive development. Pneumatization of middle turbinate intermediary one or several ethmoid cells is referred to "concha bullosa", which belongs to the frequent and clinically significant variations of bony nasal cavity. The collection of 309 (176 male and 133 female) adult dry skulls pertaining to the "Broumov Ossuary" (13th-18th centuries) was examined for the presence of concha bullosa. The appearance of the middle turbinate was evaluated by inspection. Only noticeably enlarged middle turbinates were rated as positive finding of concha bullosa. All positive findings of concha bullosa were also verified by their probing; coronal CT examination of the nasal cavity and paranasal sinuses was performed in seven of them. Concha bullosa was diagnosed in 160 skulls (51.77%).     

鼻内镜下泪囊鼻腔吻合术的解剖学基础

目的为提高内镜下泪囊鼻腔吻合术的有效率和减少并发症提供解剖学基础。方法 15具(30侧)头颈部标本经双侧颈总动脉灌注红色乳胶,在国产手术显微镜下进行解剖,1具保留骨骼的头颈部血管铸型标本。结果①外鼻的动脉:分布到外鼻的动脉非常丰富,主要有鼻背动脉、鼻外侧动脉、鼻翼动脉、鼻翼下缘动脉及上唇动脉的分支等,且在鼻端处它们之间形成非常丰富的吻合;②鼻中隔动脉:鼻中隔血供属多源性,主要来自鼻后中隔动脉上支、下支,筛前?筛后动脉,筛前、筛后动脉主要分布于鼻中隔上部;③鼻腔外侧壁的动脉:蝶腭动脉大多(90%)在蝶腭孔处已分为鼻后外侧动脉和鼻后中隔动脉,鼻后外侧动脉发出下鼻甲动脉和中鼻甲动脉;下鼻甲动脉沿途分支分布于下鼻甲及下鼻道,且有分支与中鼻甲动脉吻合。结论本文结果对鼻内镜下泪囊鼻腔吻合术具有参考价值。     

Anatomical variations of the lateral nasal wall: The secondary and accessory middle turbinates

The aim of the current anatomical and clinical study was to audit our cases of patients who presented with secondary and/or accessory middle turbinates during a two-year period. We investigated the incidence and the clinical impact of these variations. Twenty-eight patients, 19 males and 9 females with a mean age of 41.5 years, representing different ethnic origins, were diagnosed with double middle turbinates based on endoscopic examination. Of those, 92.8% had a main symptom of refractory frontal headache. A secondary nasal symptom was sensation of blocked nose. Patients who underwent endoscopic surgery (n = 13) for reduction of the extra turbinate, reported significant symptom scores improvement (P < 0.0001) of frontal headache and blocked nose, from means of 9.07 ± 0.26 and 8.57 ± 1.39 to 1 ± 0.31, and 1.42 ± 0.35, respectively. Our results indicate that double middle turbinates may be encountered in rhinology practice (2%). Clinically they may present with refractory headache and blocked nose. Endoscopic surgical approach seems to be an effective way of improving the symptoms.     

Lymphocytes and nonlymphoid cells in human nasal polyps

Immunohistochemical stainings were performed on polyp specimens of 48 patients and on mucosal biopsy specimens of the middle and inferior turbinates of 23 and 28 patients, respectively. Significantly more CD8+ (suppressor/cytotoxic) than CD4+ (helper/inducer) cells were found in the polyps. The number of CD2+, CD4+, and CD8+ lymphocytes in nasal polyps were very similar to the number in the macroscopically unaffected mucosa of the middle turbinates, whereas scores in the inferior turbinates were lower. In healthy subjects, the differences were smaller. CD22+ B cells were detected in varying numbers in the polyps in more or less organized clusters. Significantly more HLA-DR+ cells were found in polyps and middle turbinates than in the inferior turbinates. Eosinophils were found in moderate to large numbers in polyps of 77% of the patients. Mast cells and plasma cells were detected in moderate numbers, whereas neutrophils were found in 35% of the patients. In the middle and inferior turbinates varying but small numbers of eosinophils, mast cells, plasma cells, and neutrophils were found. In considering these findings, the role of chronic inflammation with T cell-dependent disturbances is discussed with regard to the pathogenesis of nasal polyps.     

Aquatic adaptations in the nose of carnivorans: evidence from the turbinates

Inside the mammalian nose lies a labyrinth of bony plates covered in epithelium collectively known as turbinates. Respiratory turbinates lie anteriorly and aid in heat and water conservation, while more posterior olfactory turbinates function in olfaction. Previous observations on a few carnivorans revealed that aquatic species have relatively large, complex respiratory turbinates and greatly reduced olfactory turbinates compared with terrestrial species. Body heat is lost more quickly in water than air and increased respiratory surface area likely evolved to minimize heat loss. At the same time, olfactory surface area probably diminished due to a decreased reliance on olfaction when foraging under water. To explore how widespread these adaptations are, we documented scaling of respiratory and olfactory turbinate surface area with body size in a variety of terrestrial, freshwater, and marine carnivorans, including pinnipeds, mustelids, ursids, and procyonids. Surface areas were estimated from high-resolution CT scans of dry skulls, a novel approach that enabled a greater sampling of taxa than is practical with fresh heads. Total turbinate, respiratory, and olfactory surface areas correlate well with body size (r(2) ≥0.7), and are relatively smaller in larger species. Relative to body mass or skull length, aquatic species have significantly less olfactory surface area than terrestrial species. Furthermore, the ratio of olfactory to respiratory surface area is associated with habitat. Using phylogenetic comparative methods, we found strong support for convergence on 1:3 proportions in aquatic taxa and near the inverse in terrestrial taxa, indicating that aquatic mustelids and pinnipeds independently acquired similar proportions of olfactory to respiratory turbinates. Constraints on turbinate surface area in the nasal chamber may result in a trade-off between respiratory and olfactory function in aquatic mammals.     

Topographic distribution area of the infraorbital nerve

The infraorbital nerve (ION) supplies the skin and mucous membranes of the middle portion of the face. This nerve is vulnerable to injury during surgical procedures of mid-face. Severe pain and loss of sense are noted in patients whose infraorbital nerve is either entirely or partially lost after these surgeries. We investigated the distribution area and topography of the ION, about which little is currently known, by dissecting 43 hemifaces of Korean cadavers. The ION produced four main branches, the inferior palpebral, internal nasal, external nasal, and superior labial branches. The inferior palpebral branch was generally bifurcated, giving off a medial and a lateral branch (58.1%). The internal nasal branch ran superior to the depressor septi muscle, along the ala of the nose. It supplied the skin of the philtrum and gave off a terminal branch that supplied the nasal septum and the vestibule of the nose. The external nasal branch was distributed diversely supplying areas between the root and the ala of the nose. The superior labial branch was the largest branch of the ION produced the most subbranches. These subbranches were divided into the medial and lateral branches depending upon the area that they supplied.     

Ultrastructural heterogeneity of the basophilic cells in the allergic nasal mucosa

Basophilic cells in scrapings and pieces of nasal mucosa removed from the inferior turbinates of adult patients with house dust nasal allergy plus pieces of the oral mucosa from normal persons were examined electron microscopically. Three distinct types of basophilic cells, ie, blood basophil leukocytes (predominantly in the subepithelium), mucosal mast cells (predominantly in the epithelium), and connective tissue mast cells (predominantly in the deeper lamina propria) were identified in the nose.     

Preliminary study on digitized nasal and temporal bone anatomy

The purpose of this study was to explore a feasible method for the reconstruction of the nasal and temporal bone structures of the Chinese virtual human project and provide a more accurate and facilitated way view them three-dimensionally (3D). The 3-D Slicer software was used to reconstruct the anatomic structures of the human nose and temporal bone. Segmentation and extraction of the contours of the ROI (region of interest) in each single slice were conducted and the processed volume data was transferred into the 3-D Slicer. After resegmentation, a set of labeled maps of the ROI were produced. Based on these maps, the 3D surface models of the tissues of interest were constructed. Four groups of paranasal sinuses, nasal septa, middle and inferior turbinates, temporal bones, tympanic cavities, mastoid air cells, sigmoid sinuses, and internal carotid arteries were reconstructed successfully. These models show spatial relationships and orientation between them. The results show that the 3-D Slicer may be used for the 3D visualization of parts of anatomic structures in the nose and temporal bone based on the first Chinese virtual human data, and thus, can facilitate the observation and understanding of the anatomic structures in this area.     

Variations of the uncinate process of the lateral nasal wall with clinical implications

The morphology of the uncinate process (UP) and nasal fontanelle is described in 119 human specimens, which were examined both before and after removal of the mucosa. Forms of the UP are classified and based on which site the process is articulated, and each form is characterized in relation to the endonasal endoscopic operative technique. Type I: The infero-posterior tip of the UP is articulated to the inferior concha (turbinate). This was the most frequently observed type. Subtype I-b: The UP adhered to the inferior concha along the antero-inferior margin. The anterior nasal fontanelle was closed by the UP adhesion; therefore, special attention is required not to damage the lacrimal bone. Type N: The tip of the UP had no articulation and made a free edge. It reduces the bony resistance at surgery. Type S: The tip articulated to the superior structures, such as the bulla ethmoid, medial orbital wall, tegument of the maxillary sinus, and basal area of the ethmoid sinus. These structures are known as high-risk areas of endonasal surgery (Levine, 1993). Type P: The tip articulated with the perpendicular plate of the palatine bone. The UP was prolonged posteriorly. Attention should be paid to the sphenopalatine artery, which goes through the posterior edge of the middle concha. Four additional variations (combinations of the above basic types, Variations IS, IP, SP, and ISP) were also observed. Clin. Anat. 11:295–303, 1998. © 1998 Wiley-Liss, Inc.     

宽鼻缩窄截骨术的临床应用解剖

目的为更好地开展鼻背缩窄截骨术并减少其并发症提供解剖学基础。方法10例20侧防腐成人头部标本用局部解剖的方法观察鼻背骨结构与周围组织的比邻关系。结果鼻背骨结构由鼻骨、上颌骨鼻突、额骨鼻突组成。其中:(1)鼻骨间缝合长度(25.2±2.91)mm;(2)鼻颌缝合长度(29.2±2.51)mm;(3)上颌骨鼻突厚度①梨状孔起点处(1.86±0.22)mm,②眶下缘平面(2.18±0.22)mm,③内眦平面(2.78±0.10)mm;⑷鼻颌沟到鼻泪管之间的距离①顶部(3.52±1.22)mm,②中部(5.10±1.48)mm,③底部(5.62±1.26)mm;⑸内眦韧带止点与鼻颌缝的距离(2.87±0.08)mm。结论鼻背缩窄的侧鼻安全截骨线为:截骨术要从下鼻甲上部的附着部位开始,于骨膜下沿鼻颌沟进行,避开鼻外侧静脉,于眼窝内下方大约相距3.5mm左右,到鼻根点部位于内侧截骨线相遇。     

Glycogen synthase kinase 3 in chronic rhinosinusitis: two faces of a single enzyme in one disease

BackgroundThe origin and pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) remain unclear. Glycogen synthase kinase 3 (GSK-3) is a unique multitasking kinase involved in the regulation of inflammation and apoptosis and is an important messenger in the downstream signaling of interleukin 6.ObjectiveTo analyze the possible role of GSK-3 in the pathogenesis of CRSwNP.MethodsWe examined tissue samples of nasal polyps and the inferior turbinate of patients with CRSwNP and the inferior turbinate of individuals without chronic sinusitis (healthy mucosa). Expression levels of GSK-3 and its inactivated form phosphorylated GSK-3 (pGSK-3) were analyzed using DNA microarray, protein array, Western hybridization, and immunohistochemical analysis.ResultsWe found increased expression of GSK-3 in both the nasal polyps and the inferior turbinate of patients with CRSwNP compared with those with healthy mucosa (P < .01). We did not observe a difference between nasal polyps and the inferior turbinate of patients with CRSwNP, but a highly significant increase in the phosphorylation rate of GSK-3 was detected in the tissue of nasal polyps compared with the turbinates of patients with CRSwNP (P < .01).ConclusionGSK-3 may play a crucial role in the inflammatory process in CRSwNP. Nasal polyps originate mainly in the mucosa of the middle meatus of the nose and rarely occur in the region of the inferior turbinate. The inhibition of GSK-3 by phosphorylation in nasal polyps, in contrast to the inferior turbinate, is a possible explanation for the different behavior of the mucosa of the middle meatus and the inferior turbinate.     

Density of goblet cells on normal adult nasal turbinates

On the basis of 10 middle and 10 inferior turbinates from autopsies on normal adults, a quantitative study of the goblet cells was performed, using the whole-mount method. There was quite some increase in density into the posterior direction, with a generally higher density on the inferior than on the middle turbinate. The results are related to the current of air in the nose.     

Prevalence of human papilloma virus and human herpes virus types 1–7 in human nasal polyposis

This study aimed to investigate the prevalence of human papilloma virus (HPV), herpes simplex virus‐1/‐2 (HSV‐1/‐2), varicella‐zoster virus (VZV), Epstein–Barr virus (EBV), cytomegalovirus (CMV), and human herpes virus‐6/‐7 (HHV‐6/‐7) in 23 human nasal polyps by applying PCR. Two types of control tissues were used: adjacent inferior/middle turbinates from the patients and inferior/middle turbinates from 13 patients undergoing nasal corrective surgery. EBV was the virus most frequently detected (35%), followed by HPV (13%), HSV‐1 (9%), and CMV (4%). The CMV‐positive polyp was simultaneously positive for HSV‐1. HPV was also detected in the adjacent turbinates (4%) and the adjacent middle turbinate (4%) of one of the HPV‐positive patients. EBV, HSV, and CMV were not detected in the adjacent turbinates of the EBV‐, HSV‐ or CMV‐positive patients. All mucosae were negative for the VZV, HHV‐6, and HHV‐7. This is the first study to deal with the involvement of a comparable group of viruses in human nasal polyposis. The findings support the theory that the presence of viral EBV markedly influences the pathogenesis of these benign nasal tumors. The low incidence of HPV detected confirms the hypothesis that HPV is correlated with infectious mucosal lesions to a lesser extent than it is with proliferative lesions, such as inverted papilloma. The low incidence of HSV‐1 and CMV confirms that these two herpes viruses may play a minor role in the development of nasal polyposis. Double infection with HSV‐1 and CMV may also play a minor, though causative, role in nasal polyp development. VZV and HHV‐6/‐7 do not appear to be involved in the pathogenesis of these mucosal lesions. J. Med. Virol. 81:1613–1619, 2009. © 2009 Wiley‐Liss, Inc.     

The pterygopalatine recess of the superior nasal meatus

The pneumatizations surrounding the pterygopalatine fossa (PPF) and closely related to the sphenopalatine foramen are anatomically variable. During the assessment of a cone beam computed tomography of a 64-year-old male patient, we found bilaterally a previously unreported anatomic variant. This was represented by a lateral or pterygopalatine recess (PPR) of the superior nasal meatus which extended in the anterior wall of the PPF and protruded within the maxillary sinus to determine a maxillary bulla. The PPR was antero-superior to the sphenopalatine foramen. Additionally were found a right nasal septal deviation, seemingly compensated by a left middle concha bullosa and a left prominent ethmoidal bulla. The superior turbinates were also pneumatized. Such anatomic variants related to the pterygopalatine angle of the maxillary sinus should be explored prior to surgical or endoscopic procedures which target the maxillary sinus, the pterygopalatine fossa, or the skull base.     

Analysis of air flow patterns in the human nose

The nasal cavity is the main passage for air flow between the ambient atmosphere and the lungs. A preliminary requisite for any investigation of the mechanisms of each of its main physiological functions, such as filtration, air-conditioning and olfaction, is a basic knowledge of the air-flow pattern in this cavity. However, its complex three-dimensional structure and inaccessibility has traditionally prevented a detailed examination of internalin vivo orin vitro airflow patterns. To gain more insight into the flow pattern in inaccessible regions of the nasal cavity we have conducted a mathematical simulation of asymmetric airflow patterns through the nose. Development of a nose-like model, which resembles the complex structure of the nasal cavity, has allowed for a detailed analysis of various boundary conditions and structural parameters. The coronal and sagittal cross-sections of the cavity were modeled as trapezoids. The inferior and middle turbinates were represented by curved plates that emerge from the lateral walls. The airflow was considered to be incompressible, steady and laminar. Numerical computations show that the main air flux is along the cavity floor, while the turbinate structures direct the flow in an anterior-posterior direction. The presence of the turbinates and the trapezoidal shape of the cavity force more air flux towards the olfactory organs at the top of the cavity.     

泪道逆行置管术联合下鼻甲骨折内移术的观察

目的：观察泪道逆行置管联合下鼻甲骨折内移术治疗鼻泪管阻塞伴下鼻道狭窄的疗效。方法：60例72眼慢性泪囊炎伴下鼻道狭窄患者按区组随机将病员分成两组,A（30例35眼）组为试验组,行泪道逆行置管联合下鼻甲骨折内移术;B组（30例37眼）为对照组,只行泪道逆行置管术;C（512例702眼）组亦为慢性泪囊炎不伴下鼻道狭窄患者,只行泪道逆行置管术。结果：一年后追踪观察,A组治愈率84．86％,有效率93．93％,B组治愈率29．41％,有效率61．76％。C组治愈率85．60％,有效率95．09％。AB两组比较有显著差异（P〈0．005）。A组和C组相比无明显差异。结论：泪道逆行置管联合下鼻甲骨折内移术治疗鼻泪管阻塞伴下鼻道狭窄的疗效比单纯行泪道逆行置管术效果好。     

The presence of a local immune system in the upper blind and lower part of the human nasolacrimal duct

The nasolacrimal duct is exposed to exogenous agents, including potentially harmful microorganisms, coming from the eye surface by the lacrimal sac, and from the nasal cavity by the inferior meatus of the nose. The upper blind and lower part of the human nasolacrimal duct were examined immunohistochemically to ascertain the presence and localization of immunoglobulin-producing cells and the epithelial expression of IgA, IgM, and IgG in order to verify the possible antimicrobial properties of this duct. IgA-, IgM-, and IgG-positive immunocompetent cells were recognizable in the lamina propria of the upper blind and lower part of the human nasolacrimal duct, while an evident immunoreactivity for sIgA, IgM, and IgG was demonstrated in the cytoplasm of the apical epithelial cells. The results suggest that all the effector components of the mucosal immune system are present in that area of the human nasal mucosa next to the opening of the nasolacrimal duct as well as in the human lacrimal sac.     

Gross morphological and morphometric study of the upper respiratory system of the African giant rat (Cricetomys gambianus,Waterhouse 1840)

The nose is a structurally and functionally complex organ in the upper respiratory tract. It not only serves as the principal organ for the sense of smell, but also functions to efficiently filter, warm, and humidify inhaled air before the air enters the more delicate distal tracheobronchial airways and alveolar parenchyma of the lungs. Despite the volume of published studies on the biology of rodents, there is no information on the gross upper respiratory morphology of the African giant rat (AGR) in the available literature. Hence, this study aimed to examine the anatomy of the turbinates, their meatuses, and the morphometry of the nasal cavity. The following were found and reported in this study: (a) There were three nasal conchae in AGR: the nasoturbinate, which was the largest; the ethmoturbinate, which was composed of one well-developed ectoturbinate and three well-developed endoturbinates; and the maxilloturbinate, which was fusiform, short, and branched. (b) Three major meatuses were observed: the dorsal nasal meatus, which was the longest and widest; the middle nasal meatus, which was without limbs but had a deep oval caudal recess; and the ventral nasal meatus, which directly continued caudally into the nasopharyngeal meatus. (c) Four ethmoturbinates with four slit-like meatuses were observed, each with dorsal and ventral limbs; the first contacted the middle nasal meatus but not the nasopharyngeal meatus. (d) There were three paranasal sinuses: one sphenoid, two frontal, and two palatine sinuses. The data obtained are relevant to pathologists and eco-morphologists, considering the burrowing habitat and behaviors of AGR, and provide baseline data for more investigative studies.